Time to Tumble Down - Again

Well, it's time to officially close this blog as the next chapter of my life begins. I realized this after the last post focused on residency issues and had little to do with medical school.

I have ascended to the highest rungs of medical education to this point and can no longer content myself as I look down on those still struggling to make the ascent. I don't even have an ID any more for my school, so it's time to move on.

Unfortunately a new challenge, a new totem pole, a new hurdle awaits and I must, regrettably, begin again at the bottom.



So thanks to everyone who linked me, read my ramblings and bitchiness, and gave support at times when I was down or celebrated as events came and went. It's been a helluva ride so far.



Everyone's welcome to come over to The Chloroform Rag, where I'll start posting from now on. See ya there.

Well, Okay Then

Received my schedule for the ER last night. It's not bad - i.e. no call and nothing more than 12 hours at a time with several days off - but it made Wife make one comment.

"You're sleep schedule is going to be all fucked up. You know that, right?"

She was referring to the accurate identification that I have shifts all over the place - including one that ends at 4am. One day I'll be working in the morning/afternoon then come back to the overnight, then back again. It's easy to see how my body is going to try and revolt over this.

But whatever. It's internship - and this is probably the best schedule I'm going to have all year. Plus everything that I thought would happen hasn't - like starting out on call, in the ICU, and working July 4th weekend. Thinking that these were inevitabilities they haven't happened. Interesting.

Necessary

I've often wondered if the 4th year of medical school is really necessary. Many medstudents spend the majority of this year taking electives in their respective desired fields, easier rotations during interview season, and often have months off with little to no patient interaction leading up to July. It's clearly no wonder that a July syndrome is often seen in many incoming interns.

I've been reviewing over the last few months, but it's hit and miss. There are things that come up and I feel guilty trying to study about diseases and physiology when the family has come home - I won't have this much time with them again in, well, probably ever. So I close the review books (because by now I've admitted that I just really should review the basics again before getting too in depth on anything) and head outside to play one-on-one with my son, teach my daughter how to ride a two-wheel, or take care of wife.

I think that a full year of 4th year, while nice in the time off you often get, really is a hinderance to many students. I knew far more and was multitudes more ready to enter the "real world" of medicine last July, not this one.

Personally I think it would be better for programs to have earlier interview times in the early fall, find out where you matched in December, and then enter your program in January or February. The students would be better prepared, less rusty, and far more capable of handling the first couple weeks of internship. The syndrome would still be in place, but not as pronounced as it is currently.

Hell, if there was a real consideration to drop the 80 hour work week to 56 we could lengthen the residency training based on reducing some of the 4th year requirements and letting med students into training 6 months earlier.

So, is a full 4th year really necessary? I don't think so.

Hoping Beyond Hope

There are several items that I hope don't happen - even though I know there's a very good chance that they'll occur anyway. Like gas stopping its ridiculous and out of control move towards $4 and $5 a gallon.

What I really hope is just merely a rumor mill is this, a cut of work hours from 80 to 56 per week. I found this link from Medschool Hell - who, naturally, is in support of the move.

I've already blogged about this topic in the past, so I will allow you to read over that post and refresh yourselves. Clearly I do not believe cutting the work-hours anymore will lead to significant changes for the better.

What it will do is just lengthen an already long process with residencies adding additional years, create further punch-clock mindsets in residents entering the work-force, and leave a large topic of discussion still on the table: debt repayment.

Hell, as it is the government has been trying to get underpaid residents to pay back on loans by reducing the years that they can defer or forbear or simply removing the option of "economic hardship" from the list of reasons. So adding more years will do what? Create more financial burdens, reduce the chance to moonlight, make residency akin to a 40 hour a week job where-in doctors will become even more hesistant to do anything past 5pm? Is that what we really want?

Think about it before you'd say that working a few less hours isn't that bad.

Oh Yeah Moments

I'm starting to think that the people who designed the home we've moved into had a few "Oh Yeah, we need that." moments.

For instance - both bathrooms are small, lack drawers, and give the impression that the architect suddenly recalled needing to have 2 bathrooms.

Today, after getting a new washer and dryer delivered I tried to run a load of laundry. Unfortunately I couldn't open the dryer door - the hinge-door on the dryer side would not allow the left to right opening that is customary on many, many, many dryers. But, after unhooking the sliding feature on the door I could swing it wide open and, with care, open the dryer. These appliances aren't anything too large, too fancy, or too anything - normal sized.

Ah yes, the Oh Yeah moment hits again.

Purification by Fire

This is the end, my beautiful friend, the end.

The coats burned nicely, soaked with lighter fluid, and a large plume of foul smelling, blackish smoke arose as I exorcised the drug-resistant demons from within. Thanks for the memories, short white coats, I hate you still.

Graduation

So the grad ceremony was nice - if not long - and my family was able to be here to watch Wife hood me. Thankfully my back, which had been acting up the last week and kept me from working out for the last 8 days, did not hurt as much as I had thought - given that we stood for an hour before walking into the arena and then stood again while 100 of us were called, walked across the stage, were hooded, and then recited the Hippocratic Oath (updated version).

I felt a swell of pride as Wife placed the hood on me, I turned and walked down the stairs and kissed her. It felt like we had arrived, but I still don't feel like a doctor. I'm sure that feeling won't come anytime soon until I hear the pager go off endlessly or am asked to assess a patient that I feel completely underprepared to deal with - wait, scratch that, I won't feel like a doctor for a while...if ever.

My parents took tons of pictures and many of the classmates and friends were in the backrooms snapping away while we readied ourselves. It was sad that so many of us had been through so much, and now we're heading off into different cities, different specialties, and different lives. I hope to keep in touch with some, but I'm not optimistic.

So, one more month and then I begin orientation. July 1st is coming fast. I think I'll post some more on this blog until June, then I'll turn the attention to my residency blog. After all, I'm no longer a medstudent.

I am a Doctor

Nothing more needs be said. Well, it will, but just not right now. I've got some partying to do!

Obesity - Dangerous To Your Health

Fat people are a danger to themselves. Health not withstanding (diabetes, hypertension, stroke, cardiac disease, arthritis, etc. are all shown to increase in patients with, um, largess) there are many more practical and truly understated reasons to remain thin:

1) radiology equipment may not be able to accomodate your size (CT or MRI scanners that can't handle the weight/ size)

2) getting any central line placed is much harder due to obliteration of normal anatomical landmarks by fat and once obtained many healthcare workers won't want to remove it even if a "potential" infection is suspected leading to possible catheter related infections

3) peripheral IV's are often obtained only through multiple, painful attempts and frequently are 22 gauge size or smaller, in the fingers or feet, lending them to being subpar for any real utilization if acutely ill

4) intubations are harder, messier, and patient's tend to decompensate faster with larger body habitus - plus bag masking is harder on someone who's chin doesn't really exist anymore

5) lumbar punctures, epidurals, spinals, etc. are much harder to obtain as, once again, normal anatomical layouts are obliterated by fat

6) beds may not be able to support you unless "special" ones are obtained which could leave you waiting in uncomfortable chairs, wheelchairs, or stretchers for prolonged periods while one is obtained

7) moving patients from stretchers to OR tables requires more personnel and once on the table you have a higher chance of falling off due to weight balance being less central

8) when incapacitated, being turned, changed, etc. is harder on the nursing staff, requiring more staff to accomplish the job, and therefore lending to potential reductions in care over time and bedsore formations

9) harder to hear heart and lung sounds - plus radiographs tend to have abnormal shadows and lines from rolls of fat which can impair diagnosis of conditions

10) many drugs are given based on ideal body weights and larger status leads to variable dosage delivery. Fat is also large storage pool for many drugs which can lead to reduced effective concentrations intially only to then have an increase as the drug stored in fat is released and joins the already circulating concentration with resultant overdosing.

Just some things to consider when the current culture tries to tell us to be "happy with yourself just as you are". Be happy, but work towards losing weight - it's best. Humans are not naturally fat.

Scary As Hell

Just found out that I will be starting July 1st in the...wait for it...

EMERGENCY DEPARTMENT! (dramatic, scary music plays as audience gasps and shrieks in horror)

Stay away from the hospitals, people, stay away.

Nothing like starting out in the level 1 trauma center for half your state and portions of bordering states, in July, when the amalgam of drink, warm nights, and fireworks will work itself into a frenzy.